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ADHD and Risky Behavior in Adults

Why risky behavior sometimes accompanies ADHD

By Katherine Kam
WebMD Feature

Reviewed by Louise Chang, MD

When Amanda, 30, was diagnosed with ADHD five years ago, she began to understand the risk-taking that had marked her teens and twenties: the drug abuse, binge drinking, and casual sex with numerous men who had flirted with her in bars.

She couldn’t put the brakes on those intensely exciting experiences, but she also despaired that her life was out of control. “Before I was diagnosed, I was depressed a lot because I just didn’t understand what was wrong,” says the Baltimore resident, whose last name is being withheld to protect her identity.

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Not every adult with ADHD engages in thrill-seeking or risky behavior. But like Amanda, many are driven to danger by impulsivity or hyperactivity -- hallmark symptoms of ADHD -- combined with a high need for stimulation and a diminished ability to grasp consequences.

As a result, they may begin courting problems early. According to the National Institute of Mental Health, in the first few years of driving, teens with ADHD are involved in nearly four times as many car accidents as peers without the disorder -- and those accidents are more likely to cause injury. Teens with ADHD also get three times as many speeding tickets.

Furthermore, in one study of adolescents, more than 50% of teens diagnosed with ADHD contracted a sexually transmitted disease, says George Keepers, MD, chair of psychiatry at Oregon Health and Science University and director of the OHSU Adult Attention Deficit Disorder Clinic. Teens with ADHD also accounted for almost all of the pregnancies that occurred during the study. “You can see that there’s a tremendous amount of risky behavior that goes with the diagnosis,” Keepers says.

Risk taking may extend into adulthood in the form of substance abuse, physical fights, habitual gambling, jumping headlong into online relationships with strangers, and other perilous or even life-threatening actions.

How might ADHD be at fault? The disorder impairs the brain’s executive functions, Keepers says, “where we form judgments, where we predict the future, where we try to conform our actions to tasks that will lead us to success, rather than to failure.”

But there’s hope when people learn that their high-risk behavior stems from ADHD. “Their likelihood of avoiding risky behaviors is very much related to whether they’re treated,” Keepers says.

Reckless Behavior Worsened

For Amanda, undiagnosed ADHD turned her school years into an ordeal. She couldn’t focus on textbooks or lectures because of inattentiveness, so she played on teachers’ sympathies to get better grades. “I sort of manipulated my entire way through school,” she says. “I literally passed by the seat of my pants.”

When she graduated from high school, she was unprepared for community college or the work world, she says. “I just felt like I couldn’t buckle down and focus on anything in my life.”